A major factor influencing the cost of skill training is the required level of supervision by a skilled practitioner. This is particularly crucial in today's health care environment in which more efficient use of medical resources is demanded. Allocating a portion of a subject's training to lower paid, less skilled assistants or having a subject train at home without professional supervision significantly reduces the labor costs. These reduced cost training programs increase the risk of inferior training outcomes because the insufficiently supervised trainee is more likely to perform tasks incorrectly, continue doing tasks which are either too simple or too difficult, or perform at a low level of intensity and motivation.
A second major factor particularly influencing the cost effectiveness of physical rehabilitation and athletic skill training is the motivation of the trainee to acquire the new skills required to enhance performance. A minority of individuals impaired either by injury or disease may have secondary reasons for slowing their recovery. For example, a worker receiving disability payments for a job related injury may prefer to remain on disability rather than have the injury rehabilitated only to return to an unsatisfying job. Similarly, an individual injured in a motor vehicle accident might be motivated to remain impaired in the hopes of winning a financial settlement. Such medical cases frequently occur in conjunction with legal actions in which a judge or jury are forced to make determinations of disability. Objective information related to a trainee's motivation to recover would be valuable in reaching these medical-legal judgments.
A third major factor particularly influencing the cost effectiveness of physical rehabilitation, but not limited to this type of program, is the quality of management. This is especially important in the realm of larger multi-facility corporate providers of training, operating with numerous practitioners. Traditionally, physical rehabilitation has been a clinical "art" in which the individual practitioner has a substantial degree of independence in determining the specific tasks used in treatment. Issues which must be addressed by quality management include: (1) Are individual practitioners adhering to the corporate standard methods used to treat specific physical disorders? (2) Are individual practitioners and patients working at the appropriate levels of motivation? (3) Are patients being adequately challenged during training to produce the best outcome in the shortest possible time? Objective information relative to the motivation, quantity, and quality of exercise tasks performed by patients would be valuable for the individuals responsible for managing the clinical program.
The challenge confronted by health care providers is to extend services to a broader population of individuals while minimizing the escalation of costs. To achieve this goal, providers must deliver their services in as cost-effective manner as possible and must concentrate services where they are likely to effect the greatest benefit. To deliver services efficiently, health care providers must select the most effective treatment approaches and predict the likely outcome of the selected approaches relative to the associated costs. For example, the demand for efficient physical rehabilitation services has become especially strong, because demand continues to increase rapidly in proportion to the growing numbers of elderly citizens.
A form of service now being implemented by providers is one which is home-based wherein a subject performs a substantial portion of prescribed training exercises at home rather than in a professionally supervised clinical environment. Rehabilitation training performed at clinics tends to be supervised by less skilled clinical aids and assistants rather than by professionally trained physicians and physical therapists. Both home-based and reduced cost clinically based approaches substantially reduce the personnel costs associated with rehabilitation training compared to the cost of services provided by professionally trained personnel. More responsibility is placed on patient motivation to perform the prescribed training exercises. When training exercises are performed in the absence of a professionally trained clinician, there is a substantially greater risk that the patient will be poorly motivated to perform at an optimal level of intensity, will continue to perform simpler, less challenging exercises when they are no longer needed, and will perform exercises incorrectly. All of these factors substantially reduce the efficacy of the rehabilitation training.
Motivation is a particularly critical factor for patients receiving physical rehabilitation for injuries sustained on the job or as a result of an accident. Many such patients are medical-legal cases for which there are potential monetary incentives for delaying recovery. The patient injured on the job may be entitled to compensation payments so long as the injury severity prevents return to work. In the case of motor vehicle and other accidents, liability payments are likely to be higher for more severe and sustained injuries. Methods and devices providing an objective evaluation of patient motivation during physical rehabilitation would be valuable not only in speeding recovery but also in exposing those patients who are poorly motivated to recover.
Although the research described below is undoubtedly applicable to a variety of training scenarios, the literature cited is taken from the current art of physical rehabilitation and athletic training. Selection of training exercises likely to yield the best outcome is typically based on information related to the trainee's medical diagnosis, results of functional performance assessments, and the trainee's goals for improvement. The functional performance assessment may employ either one or a combination of objective machine based and subjective observationally based methods. The current clinical literature suggests that information related to diagnosis and functional performance contribute useful information to the processes of selecting the most effective training tasks and predicting the progress and outcome of performing said tasks.
It is generally accepted in the scientific literature pertaining to motor learning and skill acquisition that the number and the intensity of practice repetitions of an exercise and the motivation of the individual performing the exercise substantially influence the speed at which a new skill is acquired and the eventual level of proficiency attained (see for example: Schmidt, Motor Control and Learning, A Behavioral Emphasis. Champaign, Ill., Human Kinetics Publishers, 1988). Thus, individuals who exert higher levels of effort performing a training exercise as well as those who spend more time performing the exercise are likely to reach higher levels of proficiency more quickly compared to individuals expending less effort and time. This finding is easily extendable to many forms of training.
Another generally accepted principle in the scientific literature pertaining to motor learning and skill acquisition is that effective skill acquisition requires matching the exercise difficulty with the individual's performance capabilities relative to the exercise (see for example: Winstein, et al, Standing balance training: effect on balance and locomotion in hemiplegic adults, Archives of Physical Medicine and Rehabilitation, 70, 1989). If the exercise is too difficult relative to a trainee's performance capabilities, the trainee's performance is poor, little if any reinforcing feedback is received, and relatively less is acquired in the way of new skill. At the other extreme, if the training task is simple relative to the performance capabilities of the trainee, the accuracy of the trainee's performance will be very high, but the trainee will lack sufficient challenge to acquire additional skill. Research studies indicate that skill acquisition is most effective when the exercise challenge enables the trainee to correctly perform approximately one-half of his attempts. The above principles of skill acquisition are understood in such diverse fields as sports training, musical performance, dance, high performance aircraft piloting, to name a few. The clinical literature suggests that these same principles of skill acquisition pertain to patients attempting to re-learn or improve skills lost through disease and physical injury (see for example: Rose, Older Adults Assessing and Treating Multiple Dimensions of Balance, Rehab Management, December/January 1997).
A well accepted principle of education is that a trainee striving to achieve a clearly defined, objective goal while receiving periodic objective feedback relative to his progress is the best motivated. Anecdotally, this principle is demonstrated by the intensity at which children and adults perform computer-based video games. Motivation is further enhanced when the trainee knows in advance that the supervising trainer will also be receiving periodic feedback regarding progress relative to the prescribed goal.
Apparatus and method for the assessment of and biofeedback training of movement coordination, strength, and speed skills are the subject of U.S. Pat. No. 5,476,103, issued Dec. 19, 1995 to Lewis M. Nashner and of U.S. Pat. No. 5,551,445, issued Sep. 3, 1996 to Lewis M. Nashner. In addition, the assessment of and biofeedback training of body coordination skills and ball-strike power and accuracy during athletic activities is the subject of U.S. Pat. No. 5,697,791 to Nashner, et al., issued Dec. 16, 1997. This art, as well as other related patent applications and other references cited in these patents, are incorporated herein by reference. The equipment and methodology disclosed in preferred embodiments provide examples of building blocks upon which the aforementioned goals of this disclosure might be realized.